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CMS has caused quite a stir this week by announcing they are shaking up their CMMI “Innovations” office.

They are looking for input on “Consumer-Directed Care & Market-Based Innovation Models” that might be beneficial to Medicare and Medicaid patients.

“What options might exist beyond FFS and MA for paying for care delivery that incorporate price sensitivity and a consumer driven or directed focus and might be tested as a model and alternative to FFS and MA?”

IP4PI founder Craig M. Wax, D.O. presents on Capitol Hill at the March 2017 meeting of the National Physicians’ Council for Healthcare Policy. Learn more about NPCHP efforts at http://npchcp.org. Read a synopsis of the principles here and view slides here.

The insurance and government dominated system is failing our patients. A physician friend of IP4PI shares this shocking example about the system claiming another victim:

A 59 y/o man presented to my last employed practice, with an almost elephantiasis swelling bilateral legs. He had pinpoint marks on the skin of his legs. He held up a jar with what looked like a couple of tiny maggots. He said, these come out of those holes every so often. I said how long has this been going on?? He said 1.5 years. “I’ve mentioned to several doctors, they just shrug and don’t do anything.” I said we would do something, and called the hospitalist immediately to admit for workup and treatment. I was directed to the nurse gatekeeper for approval for admission. What’s wrong, she asked. “4+ edema in both legs, which are also full of maggots.” Hmmm, she said. There is no medicare admissible diagnosis of ‘maggots in legs’. What about his rising creatinine of 1.7? Not bad enough to qualify under guidelines. Call us back if it gets worse. I did try to do some outpatient workup, but I think the man was disgusted. He never followed up. He was dead within the year.

Does anyone think about or have we even tried to come up with our own physician based contract proposal to insurers that could be a way of negotiating our independence as an alternative to their railroading contracts? Since we know that DPC works, cost less and provides better care more efficiently and that insurance will morph to continue to keep its revenue stream, perhaps we should offer up a contract of our own.

Since we don’t like their offer should we have a counter proposal that requests what we want in a legal document that can be validated and support legal recourse in “a partners agreement” instead of the current “employee-employer contract” and that the insurers must be accountable to in court to this new contract?

Simply stated it might read something like this (with 11 pages of legalese from our lawyers that structures the responsibilities and supports the clarity of the following):

patients come first

physicians have a right to receive pay for services rendered.

insurers pay patients according to their contracts, not physicians

patients pay physicians directly

patients have the right to decide what they will accept as personal risk in their health and in their financial circumstances.

insurers may not interfere in any way with the decision making of the patient in concert with the physician.

insurers may not set pricing restrictions on physicians. They may however set limitations in their service contract with the patient on what they will cover in their contract.

physicians have the privilege and the right to support their patients in their efforts to obtain quality healthcare delivery and insurance coverage

physicians have the right to personal privacy and protect patient privacy by only allowing data stripped of unique identifiers to be collected and stored centrally. Centralized charting must not contain any unique identifiers other than the physicians delivery of care office information.

Please add on or discuss as you see fit!

This discussion might lead to some sort of standardized counter offer to insurers since so many physicians are afraid to leave that system which has steadily moved toward indentured servitude.

Just ask yourself who loses out in a true free market solution – Insurance cos, Elites of academia and Quality/Certification cartel, and administrators and it’s clear why these special interests object so strenuously. It’s no secret there will always be millions of people who can’t pay for insurance, but let’s identify those costs clearly so taxpayers will understand the impact, as they are the ones paying for it. There can’t be a worse method of shifting costs to taxpayers than the current ACA subsidies. To state that current system works great as long as subsidies are maintained is ridiculous.